Cross-Roundtable Summary in English

OurCareCommunity Roundtables

Asummaryof10conversationswith equity-deservingcommunitiesacross Canadaaboutimprovingprimarycare

AboutOurCareCommunityRoundtables

BetweenJuneandDecember2023,OurCarehostedconversations withpeoplefromsomeofthemostequity-deservingcommunities inCanada–peoplewhohavehistoricallyhadpooraccessto primarycare,whosevoicesaretoooftenleftoutofpublic consultationsbutwhoalsohavestrength,wisdomandinnovative ideasabouthowtoimprovetheircollectivewell-being.

Weheld10CommunityRoundtables,twoeachinBritishColumbia, Manitoba,Ontario,QuebecandNovaScotia.

Collectively,wemetwith192peoplefromacrossthecountry includingFirstNations,InuitandMétis(FNIM)peoples;membersof theAfrican,CaribbeanandBlackcommunities;immigrants,refugee claimants,migrantworkersandothernewcomers;peoplewith disabilities;andmembersoftheLGBTQIA+community.

Thisexecutivesummaryhighlightscommonthemesfromthe OurCareCommunityRoundtables.Fullreportsfromeachofthe roundtablesareavailableatOurCare.ca.

TheCommunityRoundtablesarethethirdphaseofOurCare,anational conversationwitheverydaypeopleaboutthefutureofprimarycarein Canada.OurCareisledbyDr.TaraKiran,afamilydoctorandrenowned primarycareresearcherbasedatMAPCentreforUrbanHealthSolutions,St. Michael’sHospital,UnityHealthTorontoandtheUniversityofToronto.

AboutOurCareCommunityRoundtables

TheOurCareCommunityRoundtableswereorganizedwiththehelp ofcommunityorganizationsthathaddeeproots,strong relationshipsandtrustwiththepeopletheyserved.Theseproject partnerscollaboratedwiththeOurCareteamtorecruitparticipants andorganizeandhosteachoftheRoundtables.Eachcollaboration wasunique,withprojectpartnershelpingshapetheRoundtable designandlogistics.

Eachconversationwasroughlysixhours,sometimesbrokenupinto twodays,usuallyinpersonthoughsometimesvirtual.The conversationwasoftenfacilitatedinmultiplelanguages.For example,thenewcomerroundtableinBritishColumbiawas simultaneouslytranslatedinfivelanguages:English,Tigrinya, Spanish,Dari,andArabic.Duringtheirtimetogether,participants learnedaboutprimarycare,discussedbarriersandfacilitatorsto careandproposedideasforchange.Thefollowingsectionsoutline therecurringanddistinctperspectivesacrosstheRoundtables.

OurCareRoundtables:CommunitiesandPartners

Province Community LanguagesSpoken Partner

British Columbia PeopleLivingwith Disabilities

Refugee,Migrant Workers,andNewcomers

English

English,Tigrinya*, Farsi-Darsi*,Arabic*,& Spanish*

Manitoba IndigenousYouth English

Refugee,Migrant Workers,andNewcomers

Ontario FirstNations,Inuitand MétisRelativeslivingon UrbanandRelated Homelands

African,Caribbean,and BlackCommunities

English,Arabic*,& Ukrainian*

English

English&French

Quebec Lesbian,Gay,Bi,Trans, Queer,Intersex,Asexual+ (LGBTQIA+)Migrants

Low-IncomeResidents, Newcomers,andAsylum Seekers

NovaScotia RefugeeClaimants

AfricanNovaScotians

English,French,Arabic, &Spanish

English&French

English,Spanish*,& Haitian-Creole*

English

CommonThemes

Racismandotherformsofdiscriminationarecommonexperiences: Discrimination,bothstructuralandindividual,wasaconsistenttheme acrossall10roundtables.Thisincludesracism-anti-Black, anti-Indigenous,andotherformsofracialprejudice–aswellas transphobia,xenophobia,anddiscriminationrelatedtodisabilities. Discriminationerodespatients'wellbeingandconfidenceandfosters distrustinhealthcaresettings.Manyparticipantsdescribedhowracism anddiscriminationledtoreluctancetoseekcarewhenneeded.

IndigenousModelsofCareareculturallydeterminedandhavealways worked:IndigenousModelsofCarehavebeeneffectiveinimprovingthe healthandwell-beingofdiverseIndigenouscommunities.Byprioritizing thedeliveryofwholistichealthsupport,addressingallfacetsofwell-being encompassingmental,emotional,spiritual,andphysicalcarethese modelsfosterdeeperconnectionswithclientsandcommunities.The emphasisonbridgingculturalgapsensuresthathealthcareistailoredto acknowledgeandrespecttheuniqueneedsofFNIMclientsand communities.Moreover,theinclusionofElders,KnowledgeKeepers, communityadvisoryboards,andtheprovisionofculturallyrelevantcare createaspacethatisbothinclusiveandresponsivetothediverse traditionsandculturesofIndigenousnations.

Expandthehealthworkforcetoreflectthediversityofthecommunity: ThereisaneedtoexpandHumanHealthResourcestoreflectthediversity ofthepopulationsservedandrespectIndigenousself-determination.In additiontoredressinginstancesofdiscriminationandhistoricalinjustice, representationinthehealthworkforcewascitedasawaytobuildtrustwith equity-deservingcommunitiesandensureculturallysafe,highquality care.

CommonThemes

Languagebarriersareasignificantchallengeinreceivinghigh-quality care:Miscommunicationandmisunderstandingbetweenpatientsand primarycareclinicianscontributestonegativeexperienceswiththehealth caresystem.Aninabilitytoaccessinformationandcareinresidents’ primarylanguagewascitedfrequentlyasachallengethaturgentlyneedsto beaddressed.

Leveraginginternationalexperienceandlearningfrombestpractices: Participantsspokeatlengthofthebarriersnewcomersfacewhentryingto usetheirskillsandtrainingintheCanadianhealthcaresystem.Thecurrent systemtakestoolongandmakesittoodifficultforinternationallytrained healthprofessionalstopracticehere.Barrierstopursuingmedicaleducation inCanadaincludehighcostsoftrainingandrestrictionsonattending post-secondaryduetoresidencystatus.Participantsfeltthesebarriers resultedinawasteoftalentandresourcesthatcouldaddressgapsinhealth humanresourcesandcontributetodiversifyingthefield.Theroundtables alsodiscussedthebenefitsoflearningfrombestpracticesfromother countries,withmanybelievingthatadaptingsuccessfulstrategiestothe Canadiancontextwouldhelpimproveaccesstocare.

Socialdeterminantsofhealthandwell-beingneedtobeconsideredin care:Costofliving,housing,andmentalhealthwereraisedconsistentlyas keycontributorstopeople’shealthandwellbeing.Manyparticipantsalso describedhavingdifficultyaffordingnecessaryprescriptionmedications, emergencycare,andmedicalequipment.Theintersectionofgender,race, spokenlanguage,andresidencystatusaddedcompoundinglayers,each impactingaperson’sabilitytoaccesscareandtheirwell-being.Formany thereisa“disconnectbetweentheperceptionofCanadaasacountrywith universalhealthcareandthereality.”

Empoweringindividualsandcommunitiesisapartofthesolution: Participantsexpressedastrongdesiretoplayanactiveroleintheir wellnessandcare.Solutionssuchashavingaccesstoone’sown medicalrecordsandhealthwellnesspromotionforyouthwere discussed.Manyparticipantsalsocalledformoreengagementand anongoingroleinthegovernanceofthehealthcaresystemfortheir communities.

Integratedandculturallysafemodelsofcareworkbest:Many participantsspokeofthepositiveexperienceswithcommunityhealth centre-typemodels.Greateraccesstointegratedteams,culturally andlinguisticallyconcordantcare,andrelationshipcenteredcare arejustsomeofthepracticesparticipantsfeltshouldbeprioritized. ThedemandandneedforIndigenousmodelsofcare,andintegrated teambasedmodelsthatactivelysupportandmeetthespecific needsofhistoricallyexcludedpopulationsfaroutstripsthe availability.

OtherThemes PerCommunity

FirstNations,InuitandMétisRelativesLivingonUrbanand RelatedHomelands:

● TheimportanceofFNIMclientandcommunity-ledcarethat isresponsivetoandmeetstheuniqueneedsandassetsof FNIMlivinginurbanandrelatedhomelandsthroughthe applicationofIndigenousknowledge,practices,andmodels.

● Currenthealthservicefundingmechanismsarepoorly matchedtothehealthserviceneedsofFNIMpopulations acrossurban,ruralandremotegeographiesanddrawon Westerndefinitionsofhealthcareandsuitabilityoften excludingordevaluingTraditionalHealersandCultural Practitioners

IndigenousYouth:

● Indigenousyouthneedinformationandsupport tonavigatethehealthcaresysteminorderto accesscarefortheirchildren,theirfamiliesand themselves.Indigenousyouthinthefostercare systemspokeofhavinglittlesupportwhen transitioningtoindependentlivingandfew adultstheycouldturntoforadviceandsupport.

● Thebarriersforyouthtogethealthcards, especiallythosestrugglingwithhomelessness orchildwelfare.Youthneedeasieraccessto healthcardsandalsofeelthehealthcards themselvesshouldbeupgradedtobe plastic/ID-stylecardsthataremoredurable andeasytocarry.

African,CaribbeanandBlackCommunities,includingAfrican NovaScotians:

● Impactedbysystemicracisminthehealthcaresystemand individualnegativeexperiences,somemembersfromACB communitiesarehesitanttoseekoutcare.Thiscanhavean intergenerationalimpact,withchildrensometimes repeatingtheirparents'actions.

● AfricanNovaScotianshavehadtorelyoneachotherdueto generationsofgovernmentneglect,andparticipantswere emphaticintheirbeliefthatmanyofthesolutionstobetter healthliewithintheircommunityspaces.

OtherThemes PerCommunity

Newcomers,MigrantWorkersandRefugeeClaimants:

● ThelackofknowledgeoftheInterimFederalHealth Programbybothrecipientsofthebenefitandcare providers

● Thepositiveimpactofnewcomerservicesin addressingbarriersoflanguage,lackofservice awareness,andhealth-systemknowledgethrough systemnavigatorsandadvocates

● Thehealthcaresystemdoesnotemphasize prevention.Participantssharedstoriesofclinicians tellingpatientsthattheirsymptomswerenotyet seriousenoughtowarranttreatment,orofnot takingthetimetoproperlyassessordiagnosea complaint.

PeopleLivingwithDisabilities:

● Livingwithdisabilitymeanshavingtonavigate non-accessiblecaresettingsandbecomingan expertinone’sowncare—andateacher

● Peoplewithdisabilitiesfacediscriminationand stereotypinginhealthcarelikemanyother Canadians.Uniquely,theyexperience“gaslighting” or“infantilization”inhealthcaresettingsdueto theirdisabilityofnotbeingbelieved,listenedtoor acknowledgedwhendisabilitiesare“invisible”(e.g., chronicpain,mentalhealth).

LGBTQIA+Communities:

● Experiencesofbeingmisgenderedordenied servicesduetotheirgenderidentity

● Experiencesoftransphobiaandfatphobiafrom providers,andalackofdiversityincareproviders arebarriersthatpreventLGBTQIA+community membersfromseekingcare

CommonIdeasforChange CommunityRoundtable

AcrosstheRoundtables,participantsoverwhelminglysupportedthe recommendationsofthepreviousProvincialPrioritiesPanels.Inaddition tothoserecommendations,theRoundtablesspecificallyhighlightedthe followingIdeasforChange:

● Addressracismanddiscriminationinthehealthcaresystemby mandatingculturalsafetytraininginallcaresettingsandensuringthe availabilitypublicrecoursemechanismsforpatientswhoexperience racismandmaltreatmentwhenaccessinghealthservices

● Recognizethetraining,certification,andexperienceofinternationally trainedhealthcareworkersbyreducingthebarrierstoaccreditationto practiceinCanada

● Ensureallcareinstitutions,includinghospitalsandclinics,inthecountry areaccessibletothosewithphysicaldisabilitiesandcanprovidecarein arangeoflanguages

● Embracewholisticapproachestohealththatconsiderspirituality, mentalhealth,sexuality,thesocialdeterminantsofhealth,aswellas physicalhealth

● ExpandandbuilduponthebestpracticesofCommunityHealthCentres andotherintegratedcaremodels

● Increasethediversityofthehealthcareworkforcewithdedicated educationalandfinancialassistanceprogramsformembersof historically-excludedcommunities

● Empowerindividualsandcommunitiestoplayaroleinsolutionstocare

● Ensureprogramsincludetrainingonpatientrightsandadvocacy resources

● Adoptanintersectional,gender-affirminglensinthedesignofhealth carespacestoensurethattheyaresafeandaccessibleforall individuals

● Createandpromoteadditionalfinancialaidprogramsforthosewhoare unabletoaffordtheirprescriptionmedication

● Increasetheaccountabilityofhealthcareprofessionalsandphysicians bystandardizingoversightproceduresandrecoursemechanismsfor malpractice

OtherIdeasforChange PerCommunity

FirstNations,InuitandMétisRelativesLivingonUrbanandRelatedHomelands:

● Implementingamodelofclient-led,community-basedcarethatisresponsiveto andmeetstheuniqueneedsandassetsofFNIMpeoplesacrossurban,ruraland removegeographiesandadvancesIndigenousmodelsofhealthandwellbeing thatapplyIndigenousapproachesandpracticessuchasrelationshipcentered carethatempowersclientstotakeleadershipintheirownhealthandwellbeing

● Advancingongoing,dedicatedfundingforIPHCOsandotherIndigenous-led spacesandservicesthatsupportmental,emotional,andspiritualhealth,in additiontophysicalhealth

IndigenousYouth:

● WorkwithlocalIndigenouscommunitiestoidentifyandappropriatelyengage IndigenousEldersandknowledgekeeperstocontributetraditionalteachingsto medicalschoolcurriculum

● WorkwithIndigenoushealthservicesandIndigenoushealthprovidersacross urban,ruralandremotegeographiestodevelopandimplementpracticumsin Indigenoushealthservicecontexts–thiswillenhanceawarenessofIndigenous worldviews,practices,andlivedrealities

● Revisingpoliciesthatpreventyouthandpeoplewhoareunhousedfromgetting healthcardsandotherformsofidentificationrequiredtoaccessservicesand supports

African,CaribbeanandBlackCommunities,includingAfricanNovaScotians:

● Collaboratewithspacesalreadytrustedbythecommunity,suchaschurches,to expandandpromoteexistingresourcesfortransportationandchildcarefor individualswhentheyseekcare

● IncreasetheamountofBlackcareprofessionalsthroughpost-secondary programsthatexpandinclusiveaccesstoracialized,francophone,andnewcomer studentsinhealthstudies

Newcomers,MigrantWorkersandRefugeeClaimants:

● Offerinformationaboutthehealthcaresystemandhowtonavigateitto newcomers.Thisinformationcouldbeavailablepre-arrivalorimmediatelyupon arrival,andshouldbeavailableinnewcomers’spokenlanguages.

● Addresslackofawarenessandclarityamongcliniciansandresidentsregarding theInterimFederalHealthProgram

PeopleLivingwithDisabilities:

● Createafederaldisabilitybenefitspecificallytosupportthehealthcareneedsof peoplewithdisabilitiesandthepeoplewhocareforthem

● Expandaccesstohomesupportforpeoplewithcognitivedisabilitiesor neurodivergence

LGBTQIA+Communities:

● Adheretoexistinghumanrightslegislationthatprotectsgenderidentityand genderidentity

● Mandatetheinclusionofgender-affirming,anti-oppressive,trauma-informed practicesinthetrainingofallstaffinmedicalsettings,clinicians,andallsupport staff

OurCareisanationalinitiativetoengagethepubliconthefutureofprimarycarein Canada.Over15months,thousandsofpeoplelivinginCanadatoldusabouttheir hopesandprioritiesforcreatinganequitableandsustainablesystemthatdelivers

TheOurCareinitiativehasbeenmadepossiblethroughafinancialcontributionfromHealthCanada,theMaxBell FoundationandEventheOdds(apartnershipbetweenMAPandStaplesCanada).Theviewsexpressedhereindo notnecessarilyrepresenttheviewsofthefunders.